Tuesday, 25 July 2017

High prevalence of CRE in Washington, D.C.


Carbapenem-resistant Enterobacteriaceae (CRE), a family of highly pathogenic antibiotic-resistant organisms, are endemic across Washington, D.C. healthcare facilities, with 5.2 percent of inpatients testing positive for the bacteria, according to new research.

As part of the Healthcare Antibiotic Resistance Prevalence -- DC (HARP-DC) project, the three agencies partnered to conduct a multi-center study of CRE in D.C. Sixteen facilities voluntarily participated, including eight acute care hospitals, two long-term acute care hospitals, one inpatient rehabilitation facility, and five skilled nursing facilities. Each facility conducted bacterial colonization surveillance over a one-to-three-day interval from January to April, 2016. The researchers used the Centers for Disease Control and Prevention CRE surveillance definition and tested all cultures at a single laboratory to ensure consistency.

Of 1,022 completed tests, 53 samples tested positive for CRE, which corresponds to a prevalence rate of 5.2 percent, confirming that CRE has become endemic in healthcare facilities in Washington, D.C. The median prevalence rate by facility was 2.7 percent, with one facility measuring as high as 29.4 percent of tested patients, indicating the potential for hyperendemicity. Male patients had a significantly higher prevalence of CRE compared to females (7.1 percent vs. 3.7 percent). Adults ages 20-39 (8 percent) also showed higher prevalence than any other age group.

Of the positive samples, 18 were determined to share genetic similarity with at least one other sample. This revealed the potential transmission of CRE within and between facilities. The ability to determine similarity of strain profiles from culture and molecular testing also enabled the researchers to detect an ongoing outbreak in one facility, further demonstrating the utility of these laboratory techniques for surveillance programs.

See:

Jacqueline Reuben, Nancy Donegan, Glenn Wortmann, et al Healthcare Antibiotic Resistance Prevalence – DC (HARP-DC): A Regional Prevalence Assessment of Carbapenem-Resistant Enterobacteriaceae (CRE) in Healthcare Facilities in Washington, District of Columbia. Infection Control & Hospital Epidemiology, 2017; 1 DOI: 10.1017/ice.2017.110

Posted by Dr. Tim Sandle